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Rationing, Responsibility and Blameworthiness: An Ethical Evaluation of Responsibility-Sensitive Policies for Healthcare Rationing. 配给、责任与可责性:医疗配给责任敏感政策的伦理评价。
IF 1.4 4区 哲学 Q3 ETHICS Pub Date : 2021-01-01 DOI: 10.1353/ken.2021.0004
Xavier Symons, Reginald Chua

Several ethicists have defended the use of responsibility-based criteria in healthcare rationing. Yet in this article we outline two challenges to the implementation of responsibility-based healthcare rationing policies. These two challenges are, namely, that responsibility for past behavior can diminish as an agent changes, and that blame can come apart from responsibility. These challenges suggest that it is more difficult to hold someone responsible for health related actions than proponents of responsibility-sensitive healthcare policies suggest. We close by discussing public health policies that could function as an alternative to contentious, responsibility-sensitive rationing policies.

一些伦理学家为在医疗配给中使用基于责任的标准进行了辩护。然而,在本文中,我们概述了实施基于责任的医疗配给政策所面临的两个挑战。这两个挑战是,对过去行为的责任可以随着代理人的改变而减少,指责可以从责任中分离出来。这些挑战表明,要让某人对与健康有关的行动负责,比责任敏感型医疗保健政策的支持者所认为的要困难得多。最后,我们讨论了公共卫生政策,这些政策可以替代有争议的、责任敏感的定量配给政策。
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引用次数: 3
Were lockdowns justified? A return to the facts and evidence. 封锁合理吗?回到事实和证据上来。
IF 1.4 4区 哲学 Q3 ETHICS Pub Date : 2021-01-01 DOI: 10.1353/ken.2021.0028
Philippe van Basshuysen, Lucie White

Were governments justified in imposing lockdowns to contain the spread of the COVID-19 pandemic? We argue that a convincing answer to this question is to date wanting, by critically analyzing the factual basis of a recent paper, "How Government Leaders Violated Their Epistemic Duties During the SARS-CoV-2 Crisis" (Winsberg, Brennan, and Suprenant 2020). In their paper, Winsberg, Brennan, and Suprenant argue that government leaders did not, at the beginning of the pandemic, meet the epistemic requirements necessitated to impose lockdowns. We focus on Winsberg, Brennan, and Suprenant's contentions that knowledge about COVID-19 resultant projections were inadequate; that epidemiologists were biased in their estimates of relevant figures; that there was insufficient evidence supporting the efficacy of lockdowns; and that lockdowns cause more harm than good. We argue that none of these claims are sufficiently supported by evidence, thus impairing their case against lockdowns, and leaving open the question of whether lockdowns were justified.

各国政府实施封锁以遏制COVID-19大流行的传播是否合理?我们认为,通过批判性地分析最近一篇论文的事实基础,“政府领导人在SARS-CoV-2危机期间如何违反了他们的认知义务”(Winsberg, Brennan, and Suprenant 2020),迄今为止还没有一个令人信服的答案。在他们的论文中,Winsberg、Brennan和Suprenant认为,在大流行开始时,政府领导人没有达到实施封锁所必需的认识要求。我们关注Winsberg、Brennan和Suprenant的观点,即对COVID-19的预测不够充分;流行病学家对相关数据的估计存在偏见;没有足够的证据支持封锁的有效性;封锁造成的伤害大于好处。我们认为,这些说法都没有充分的证据支持,因此削弱了他们反对封锁的理由,并留下了封锁是否合理的问题。
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引用次数: 10
Truthfulness and Deceit in Dementia Care: An argument for truthful regard as a morally significant human bond. 痴呆症护理中的真实与欺骗:关于真实关怀是一种道德上重要的人类纽带的论证。
IF 1.4 4区 哲学 Q3 ETHICS Pub Date : 2021-01-01 DOI: 10.1353/ken.2021.0020
Philippa Byers

This paper presents a challenge to the view that benign 'white lies' may be therapeutic in dementia care and preferable to more truthful alternatives. Drawing on Sissela Bok and Bernard Williams, the paper develops three key points: first, that another person's dementia is not a reason to suspend one's customary reluctance to deceive others; second, that the commonly drawn contrast between benign deceit and blunt disclosure is too simple to frame arguments for the acceptability of deceit in dementia care; and third, truthful regard-regard for a person living with dementia as one for whom truth matters, as it does for oneself-is a foundation for beneficent concern that is neither infantilizing nor condescending. The paper proposes that a morally significant human bond is established through regard for another person as one for whom truth matters, just as it does for oneself, irrespective of another's dementia, and that within dementia care, the commission of deceit should be seen as an unsettling exception to a general principle of truthfulness.

这篇论文提出了一个挑战的观点,良性的“善意的谎言”可能是治疗痴呆症护理和更真实的选择。借鉴西西拉•博克和伯纳德•威廉姆斯的观点,论文提出了三个关键点:首先,一个人的痴呆症不能成为一个人暂停惯常不愿欺骗他人的理由;其次,善意的欺骗和坦率的披露之间的普遍对比过于简单,无法为痴呆症护理中欺骗的可接受性提供论据;第三,真诚的关怀——把一个患有痴呆症的人当作一个关心真相的人,就像关心自己一样——是慈善关怀的基础,既不是幼稚化,也不是居高俯下。这篇论文提出,一种具有道德意义的人类纽带是通过把另一个人视为真理重要的人而建立起来的,就像对自己一样,不管对方是否患有痴呆症,在痴呆症护理中,欺骗行为应该被视为诚实一般原则的一个令人不安的例外。
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引用次数: 0
Editor's Note, September 2021. 编者按,2021年9月。
IF 1.4 4区 哲学 Q3 ETHICS Pub Date : 2021-01-01 DOI: 10.1353/ken.2021.0019
Quill Kukla
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引用次数: 0
Hidden Costs of Inquiry: Exploitation, World-Travelling and Marginalized Lives. 探究的隐性成本:剥削、世界旅行和边缘化生活。
IF 1.4 4区 哲学 Q3 ETHICS Pub Date : 2021-01-01 DOI: 10.1353/ken.2021.0010
Audrey Yap
There are many good reasons to learn about the lives of people who have less social privilege than we do. We might want to understand their circumstances in order to have informed opinions on social policy, or to make our institutions more inclusive. Or we might want to cultivate empathy for its own sake. Much of this knowledge needs to be gained through social scientific or humanistic research into their lives. The entitlement to theorize about or study the lives of marginalized others is often granted under the framework of freedom of inquiry or academic freedom. I will not question, in this paper, whether academic freedom licenses us to do so in the first place (see XXX this issue, for consideration of those questions); instead, I will highlight tensions between the moral-epistemic imperative to learn about the lives and circumstances of people who are relatively marginalized, and the cost to marginalized people and communities of making that learning possible. This list of considerations is not intended to be exhaustive, but will illustrate a range of ways in which good intentions on the part of researchers is insufficient to mitigate harm.
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引用次数: 1
The Epistemic Duties of Philosophers: An Addendum. 哲学家的认识义务:附录。
IF 1.4 4区 哲学 Q3 ETHICS Pub Date : 2021-01-01 DOI: 10.1353/ken.2021.0023
Philippe van Basshuysen, Lucie White

In "Were Lockdowns Justified? A Return to the Facts and Evidence", we argue that Eric Winsberg, Jason Brennan and Chris Surprenant fail to make their case that initial COVID-19 lockdowns were unjustified, due to the fact their argument rests on erroneous factual claims. As is made clear by a response in this volume, the authors mistakenly take us to have been defending the imposition of lockdowns. Here, we clarify the aims of our original paper, and emphasise the importance of getting the facts right when making philosophical arguments in such a contentious domain.

在《封锁合理吗?》在《回归事实和证据》一书中,我们认为,埃里克·温斯伯格、杰森·布伦南和克里斯·苏普伦特未能证明最初的COVID-19封锁是不合理的,因为他们的论点建立在错误的事实主张之上。正如本卷中的一篇回应所表明的那样,作者错误地认为我们一直在为实施封锁辩护。在这里,我们澄清了原始论文的目的,并强调在这样一个有争议的领域进行哲学论证时,获得正确事实的重要性。
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引用次数: 2
Free Speech Skepticism. 言论自由怀疑论。
IF 1.4 4区 哲学 Q3 ETHICS Pub Date : 2021-01-01 DOI: 10.1353/ken.2021.0008
Susan J Brison

If the free speech clause of the First Amendment is interpreted to mean that speech is to be granted special protection not accorded to other forms of conduct, then a free speech principle, distinct from a principle of general liberty, must be posited and must receive a distinct justification. A defense of a free speech principle must explain why the harm principle either does not apply in the case of speech or applies with less force than in the case of all other forms of human conduct. In this article, I argue that none of the defenses of the right to free speech on offer succeeds in showing why even significantly harmful speech is deserving of special protection not afforded non-speech conduct. More work needs to be done to justify a free speech principle and, until such work is done, the belief in the existence of a free speech principle that undergirds and justifies our current free speech practices is no more than an article of faith.

如果《第一修正案》的言论自由条款被解释为言论应受到不给予其他形式的行为的特殊保护,那么必须提出一个不同于一般自由原则的言论自由原则,并且必须有一个明确的理由。对言论自由原则的辩护必须解释为什么伤害原则要么不适用于言论,要么比适用于所有其他形式的人类行为的力度更小。在这篇文章中,我认为没有一个对言论自由权的辩护能够成功地说明为什么即使是非常有害的言论也值得特别保护,而不是给予非言论行为。需要做更多的工作来证明言论自由原则的正当性,在这些工作完成之前,对言论自由原则的存在的信念,作为我们目前言论自由实践的基础和理由,只不过是一种信仰。
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引用次数: 1
The Evolving Social Purpose of Academic Freedom. 学术自由的社会目的演变。
IF 1.4 4区 哲学 Q3 ETHICS Pub Date : 2021-01-01 DOI: 10.1353/ken.2021.0012
Shannon Dea

In the face of the increasing substitution of free speech for academic freedom, I argue for the distinctiveness and irreplaceability of the latter. Academic freedom has evolved alongside universities in order to support the important social purpose universities serve. Having limned this evolution, I compare academic freedom and free speech. This comparison reveals freedom of expression to be an individual freedom, and academic freedom to be a group-differentiated freedom with a social purpose. I argue that the social purpose of academic freedom behooves an inclusive approach to group differentiation.

面对言论自由对学术自由的日益替代,我认为后者具有独特性和不可替代性。学术自由随着大学的发展而发展,以支持大学服务的重要社会目标。在描述了这种演变之后,我比较了学术自由和言论自由。这种比较揭示了言论自由是一种个体自由,而学术自由是一种具有社会目的的群体分化自由。我认为,学术自由的社会目的需要一种包容性的方法来区分群体。
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引用次数: 0
Continued Confinement of Those Most Vulnerable to COVID-19 继续限制最易感染COVID-19的人
IF 1.4 4区 哲学 Q3 ETHICS Pub Date : 2020-11-14 DOI: 10.1353/ken.2020.0021
S. Hurst, Eva Maria Belser, C. Burton-Jeangros, Pascal Mahon, C. Hummel, Settimio Monteverde, T. Krones, Stéphanie Dagron, C. Bensimon, Bianca Schaffert, Alexander H. Trechsel, Luca Chiapperino, Laure Kloetzer, T. Zittoun, R. Jox, Marion Fischer, A. D. Ave, P. G. Kirchschlaeger, S. Moon
ABSTRACT:Countries deciding on deconfinement measures after initial lock-downs in response to the COVID-19 pandemic often include the continued confinement of those most vulnerable to the disease in these plans as a matter of course. Such continued confinement, however, is neither innocuous nor obviously justified. In this paper, we examine more systematically the requirements for the protection of vulnerable persons, the situation in institutions, legal implications, requirements to sustain vulnerable persons, and self-determination. Based on this exploration, we recommend that continued confinement cannot be the only measure in place to protect vulnerable persons. Protections are needed to enable participation in the public sphere and the exercise of rights for persons particularly vulnerable to fatal courses of COVID-19. The situation in long-term care homes warrants particular caution and in some cases immediate mitigation of lock-down measures that have isolated residents from their caregivers, advocates, and proxies. Vulnerable persons should retain the choice to place themselves at risk, as long as they do not impose risks on others. Vulnerable persons who choose to remain in confinement should be protected against loss of their jobs or income, and against the risk of discrimination in the labor market. Risk and crisis communication stresses the importance of listening to the people and setting up participatory approaches. Associations and lobbies representing the views of groups of those particularly vulnerable to COVID-19 (e.g., the elderly, those with diseases placing them at particular risk) should be consulted and involved in outlining deconfinement measures. Moreover, most vulnerable persons are autonomous and competent and should be allowed to voice their own opinion.
摘要:为应对新冠肺炎疫情,各国在最初封锁后决定解除限制措施,通常会理所当然地在这些计划中继续限制最易感染该疾病的人。然而,这种持续的监禁既不无害,也显然是合理的。在本文中,我们更系统地研究了保护弱势群体的要求、机构中的情况、法律影响、维持弱势群体的需求以及自决。基于这一探索,我们建议继续监禁不能成为保护弱势群体的唯一措施。需要提供保护,使特别容易感染新冠肺炎致命疾病的人能够参与公共领域并行使权利。长期护理院的情况需要特别谨慎,在某些情况下,需要立即缓解将居民与照顾者、倡导者和代理人隔离的封锁措施。弱势群体应保留将自己置于危险之中的选择权,只要他们不将风险强加给他人。选择继续监禁的弱势群体应受到保护,以免失去工作或收入,并避免在劳动力市场受到歧视的风险。风险和危机沟通强调倾听人民意见和制定参与性方法的重要性。应咨询代表特别容易感染新冠肺炎群体(如老年人、患有使他们面临特殊风险的疾病的人)意见的协会和游说团体,并让他们参与制定解除限制措施。此外,大多数弱势群体都是自主和有能力的,应该允许他们发表自己的意见。
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引用次数: 2
Structural Stigma, Legal Epidemiology, and COVID-19: The Ethical Imperative to Act Upstream 结构性污名、法律流行病学和COVID-19:采取上游行动的道德必要性
IF 1.4 4区 哲学 Q3 ETHICS Pub Date : 2020-11-14 DOI: 10.1353/ken.2020.0018
D. Goldberg
ABSTRACT:The primary claim of this paper is that COVID-19 stigma must be understood as a structural phenomenon. Doing so will inform the interventions we select and prioritize for the amelioration of such stigma, which is an ethical priority. Thinking about stigma as a macrosocial determinant of health driven by structural factors suggests that downstream remedies are unlikely to be effective in significantly reducing stigma. This paper develops and defends this claim, setting up a recommendation to use a “bundle” of legal and policy levers at meso- and macro- levels to reduce the adverse and inequitable impact of COVID-19 stigma. In Section II, this commentary offers a basic account of the concept of stigma in general, the justification for conceptualizing it as a structural phenomenon, and some of the basic advantages of doing so. Section III moves on to frame infectious and communicable disease stigma in Western history not only as a way of demonstrating its structural features, but also to highlight the use of laws and policies as levers for public health change. Section IV urges explicit adoption of insights and methods from legal epidemiology and offers examples of specific legal and policy recommendations for addressing these stigmas. Section V concludes.
摘要:本文的主要主张是,新冠肺炎耻辱必须被理解为一种结构性现象。这样做将为我们选择并优先考虑的干预措施提供信息,以改善这种污名化,这是道德上的优先事项。将污名视为由结构性因素驱动的健康的宏观社会决定因素表明,下游补救措施不太可能有效减少污名。本文发展并捍卫了这一主张,提出了一项建议,即在微观和宏观层面使用“一揽子”法律和政策杠杆,以减少新冠肺炎耻辱的不利和不公平影响。在第二节中,本评论对污名的概念进行了一般性的基本描述,将其概念化为一种结构性现象的理由,以及这样做的一些基本优势,但也要强调利用法律和政策作为公共卫生变革的杠杆。第四节敦促明确采用法律流行病学的见解和方法,并举例说明解决这些污名的具体法律和政策建议。第五节结束。
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引用次数: 1
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Kennedy Institute of Ethics Journal
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